Unravelling Psychopathy: Psychodynamic perspectives on working with personality disorders - 12 March 2016, London

Following our previous conference on the psychodynamics of murderousness, and again in association with the International Association for Forensic Psychotherapy, this day offers five talks by eminent forensic mental health professionals on the topic of personality disorders. The presenters will address the nature of personality disorder – sometimes known as psychopathy or as sociopathy or antisocial personality – in an effort to understand the causes and the possible treatments. The lectures will address some compelling questions: What causes personality disorders? How might we become more adept at detecting such patients, many of whom hide behind a façade of charm and deception? How best should we treat these people, and are they amenable to psychotherapeutic processes? Can liars be psychoanalysed? Are men more psychopathic than women? Join us for cutting-edge psychodynamic thinking about personality disorders and their treatment.

How much smoke do you need for a smoking gun? The psychodynamics of Personality Disorder
With the help of clinical material, this presentation will explore the counter transference in relation to the personality disorder. It is possible to classify the responses aroused by such patients under three headings: collusion, disbelief and condemnation. In treatment of the personality disorder, and in particular the psychopath, projective identification stirs our own sadism and this leads to two-fold response: either disbelief or condemnation. The psychopath despises the person who holds onto an illusion that he is good. Unconsciously he knows that it is a rejection of an important part of him, and will always give a strong clue about the hidden side of his character. If we accept what we see in the psychopath then we have to accept our own sadism. It may be more comfortable to believe that he and I are good.

Dr Jessica Yakeley

Antisocial personality disorder and psychopathy: a mentalization-based framework
Individuals diagnosed with antisocial personality disorder (ASPD) or psychopathy continue to be viewed by many as untreatable. However, psychopathy and ASPD are not synonymous and there is convincing evidence that a subgroup of individuals with medium to low psychopathy scores have suffered early trauma and attachment difficulties which have contributed to their personality pathology as adults. Mentalization-based therapy is based on attachment theory and offers a credible treatment for people with ASPD. Jessica Yakeley will present findings from an ongoing project developing and researching new MBT community services for ASPD nationally, which has been commissioned by the Ministry of Justice and Department of Health as part of the Personality Disorder Offender Pathway Strategy.

Dr Colin Campbell

Addressing psychopathy as a treatment obstacle in the management of personality disordered offenders
Recent evaluations of interventions for psychopathy have challenged the historical notion that individuals who meet criteria for psychopathy are untreatable. However, it continues to be used as the basis on which individuals are excluded from services, either explicitly, where it may be an exclusion criterion, or by less conscious processes. This paper will review recent initiatives to address psychopathy as a treatment obstacle in the management of personality disordered offenders in a range of secure settings. It will also explore the meaning and function of psychopathy as a factor limiting access to treatment, using illustrative clinical material.

Ms Anna Motz with discussant Dr Estela Welldon

The Many Faces of Eve
In this talk Anna Motz will describe the unique manifestations of female perversion and violence, with illustrative clinical material.She will draw on Welldon’s (1988) model of female personality and consider in particular whether the concept of psychopathy has any relevance to women, or if it is a misappropriation of a construction related to men. She will also describe societal responses to crimes perpetrated by women, and how details of the potential for female violence and perversion only serves to perpetuate unhelpful stereotypes and vilify those women. Finally, she will outline therapeutic approaches for working with violent and sadistic women.

Dr Celia Taylor

Psychopathic personalities and the impact on the clinician
Working with people with antisocial or psychopathic personality disturbance can have a profound impact on clinicians. Many of the offences committed by these individuals are of a highly sadistic kind and therefore traumatic to hear about and process, leading to angry and punitive responses. On the other side of the coin, some staff identify strongly with the victim within the offender, since childhood histories of appalling abuse and disrupted attachments are common. Team splitting and conflict frequently ensue, thus undermining the best efforts at treatment. This talk will consider the dynamics impacting on teams’ ability to function together in this work, and what measures can be taken to mitigate these effects.